Individual ProviderKrystan KimblePhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address190 E Bannock St, Boise, ID 83712-6241(208) 381-5500PECOS EnrollmentBased on the most recent information from CMS, provider Krystan Kimble is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 9:43 AM.Profile DetailsProvider ID1346868163Provider TypeIndividualFull NameKimble, KrystanGenderFemaleSole ProprietorNoEnumeration Date7/8/2020Last Updated1/2/2026Contact InformationPractice LocationPractice Address190 E Bannock St, Boise, ID 83712-6241Phone(208) 381-5500Fax(208) 381-2555Mailing LocationMailing Address190 E Bannock St, Boise, ID 83712-6241PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363A00000XPrimaryDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicense8461874IdahoCode363A00000XDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicenseUnlisted Issuer